Ongoing Maternal-Child Transmission of HIV in an Urban Area, 2003–2012

Abstract

Background and Objective: Mother-to-child transmission of HIV can be prevented by prenatal and peripartum interventions. We sought to determine the prevalence of vertical HIV transmission in an urban cohort of HIV-exposed infants and describe cases of vertical HIV infection presenting during and after the neonatal period. Methods: This retrospective cohort study included HIV-exposed infants born between July 1, 2003, and June 30, 2012, who received care at an urban referral site. Results: There were 516 infants with HIV exposure known by the time of delivery; 9 of these infants (1.7%; 95% confidence interval: 0.8%–3.3%) were HIV infected. The HIV infection rate was 0.7% for those receiving prenatal antiretroviral (ARV) therapy and 9.3% for those receiving only intrapartum and/or postnatal ARV therapy. Among those diagnosed with HIV at delivery, 46% received no prenatal care. Conclusions: Our data suggest that strategies to eliminate infant HIV infections ought to include ensuring better access to prenatal care, HIV testing, and ARV therapy initiation during pregnancy.